The Role of Embolic Protection Devices in Renal Artery Stenting

Division of Vascular Surgery, Southern Illinois University, Springfield, Illinois, USA.
Perspectives in Vascular Surgery and Endovascular Therapy 10/2007; 19(3):266-71. DOI: 10.1177/1531003507305269
Source: PubMed


Renal artery angioplasty and stenting is commonly performed for the treatment of hypertension and ischemic nephropathy. An increasing number of procedures are being undertaken for "renal preservation" despite an associated risk of renal function decline related to the embolization of atheromatous debris liberated during the procedure. Although smaller, more flexible guidewires and stents have been developed to decrease the amount of debris created, interest in the off-label use of embolic protection devices has increased. We review the available embolic protection devices and currently available data regarding their use in renal artery interventions. Although not designed for use in the renal artery, there are at least theoretical reasons to believe that embolic protection during renal artery angioplasty may improve outcomes.

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    ABSTRACT: To present clinical outcomes with the use of embolic protection devices (EPDs) and renal artery stents in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS). A retrospective study was conducted in 23 patients with RAS and CRI who were treated with renal artery stent placement with an EPD. Follow-up data were obtained through medical records. In 23 patients (18 men; 78%) with an average age of 69.4 years +/- 11 (range, 46-86 y), 32 renal arteries were treated for worsening renal function (n = 17; 74%) or uncontrolled hypertension and worsening renal function (n = 6; 26%). Nine FilterWire EZ devices were used in eight patients (35%) and 17 SpideRX devices were used in 15 patients (65%). The average follow-up was 8 months +/- 5. After the stent procedure, the mean systolic blood pressure decreased significantly (P < .05) whereas the diastolic pressure remained unchanged. There was a significant increase in the mean estimated glomerular filtration rate from 32.9 mL/min +/- 12.9 at baseline to 41.3 mL/min +/- 13.7 at last follow-up (P < .05). In 96% of patients, there was improvement or stabilization of kidney function. In six of the 17 SpideRX devices (35%), macroscopically evident embolic material was observed in the device after stent placement. There were two minor and two major complications. Renal artery stent placement combined with the use of a SpideRX or FilterWire EZ device is associated with an good clinical outcome with a reasonable safety profile.
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    ABSTRACT: Atherosclerotic renal artery stenosis (RAS) is increasingly recognized as a cause of severe secondary hypertension, renal dysfunction and end-stage renal failure. Percutaneous transluminal angioplasty with or without stenting of the renal artery has become the preferred mode of revascularization for RAS and has demonstrated beneficial effects with regards to improving control of hypertension and renal function in selected patients. Distal embolization of atherosclerotic debris during renal angioplasty and stenting is among the most feared complication of renal artery intervention. This paper aims to review the role of embolic protection devices in renal artery stenting for atherosclerotic renal artery stenosis.
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    ABSTRACT: Date written: November 2008 Final submission: August 2009
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